title: Less use of standard guideline-based treatment of myocardial infarction in patients with chronic kidney disease: a Danish nation-wide cohort study.
abstract: OBJECTIVE
  The aim of this Danish nationwide study was to evaluate the treatment of myocardial infarction (MI) in patients with non-end-stage chronic kidney disease (CKD) and in patients requiring renal replacement therapy (RRT). Upgraded guidelines for the management of MI were implemented around 2004; hence, the treatment of MI in the time periods before and after 2004 was compared in order to evaluate the impact for patients with CKD.
  
  
  RESULTS
  By linking nationwide registries by the personal registration number, we identified patients admitted to Danish hospitals with first time MI in the period 2000-09 (79 585 with no renal disease, 3144 with non-end-stage CKD, and 725 requiring RRT). Cox proportional hazards model was used to estimate the chance of invasive treatment within 60 days after MI and the chance of filling prescriptions on recommended post-MI drugs within 90 days before and after 2004. Significantly less use of relevant MI treatment in patients with non-end-stage CKD and patients requiring RRT compared with patients with no renal disease were seen; however, the absolute frequencies of invasive procedures and filled prescriptions on post-MI drugs increased after 2004 in all patients.
  
  
  CONCLUSIONS
  After 2004, invasive and pharmacological treatment of first-time MI improved in patients with non-end-stage CKD and patients requiring RRT; however, all CKD patients were less treated with standard MI care compared with patients with no renal disease.
authors.affiliation: The Danish Health and Medicines Authority, Axel Heidesgade 1, København S 2300, Denmark.
authors.forename: Thalia Marie
authors.initials: TM
authors.lastname: Blicher
authors.forename: Kristine
authors.initials: K
authors.lastname: Hommel
authors.forename: Jonas Bjerring
authors.initials: JB
authors.lastname: Olesen
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Mette
authors.initials: M
authors.lastname: Madsen
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Kamper
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003718:Denmark / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D055553:Prescription Drugs / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D061665:Time-to-Treatment
chemical_list: D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D010975:Platelet Aggregation Inhibitors; D055553:Prescription Drugs
keywords: Angiography; Chronic kidney disease; Coronary revascularization; Myocardial infarction; Pharmacological treatment; Renal replacement therapy